So if you’re not in the line-up to apply for medical school, what interest could this possibly hold for you?The training of medical professionals plays an enormous – and understated role – in the functioning of the medical system that is helmed by people who have survived this training regimen.It starts before the MCAT, but this test is emblematic of some of the sustaining flaws that drive classical medical training, and some of the places where real reform might create sustainable change in the overall health care system.

The traditional MCAT covers the core sciences required of premed students: physics, chemistry, biology, a little biochemistry.It tests stamina as dearly as knowledge, and does well to predict “success” in medical school, as measured by the ability to pass subsequent tests and achieve reasonable scores of the various board exams required along the way.It is notoriously poor at predicting ethics, clinical performance, or personalities compatible with patient care, and this is part of the current drive for reform.Critics of reform argue that these traits are picked up in personal statements and interviews – the MCAT is a test of knowledge, dedication, and stamina that is necessary to weed out unprepared students without sufficient mental moxy for the program; pro-reform proponents advocate for inserting material coverage psychology or sociology, or adding personality inventories alongside the exam.

All of these, I argue, fundamentally miss the point.No one, I believe, thinks that medical education should be less rigorous.It is the content of medical education – from the MCAT on up – that needs a fundamental shift, and that idea is hardly even on the table.

As it stands today, medical students take four years of undergraduate courses (in any field, though including the core science courses), then complete two years of pre-clinical studies, two years of clinical rotations, and a minimum three-year residency.Of these minimum eleven years of study, you may be surprised to know that fully half (the undergraduate and pre-clinical years) are only tangentially related to what a medical student ends up doing with their life; the rest are an amalgam of requirements and hoops that largely defy any utility to the task of medicine.This starts with the MCAT and the requirements that drive it; it continues with the first step of US Medical Licensing Examination, which covers such gross detail of non-clinical topics that medical schools are forced to focus away from clinical medicine for the first two years if only to get students to pass this exam.School to school and administrator to administrator, medical colleges are themselves are not immune from promulgating the idea that every student should take a rapt interest in the minutiae of topics that certainly hold distant relevance to medicine, but simply cannot be memorized at that detail with massive expansion of knowledge the world is currently experiencing.

The worst offender of my pre-clinical years was a neuroscience course in which we memorized in agonizing minutiaea the microanatomy of every nerve course through the spinal cord at a level of detail that was beyond most practicing neurosurgeons; we glossed over salient issues like anti-depressants, biological bases of behavior, and neurological disease in 15 minute spurts.When negative feedback about the non-clinical focus of the course reached the director, he nonchalantly dismissed these concerns by telling us, “Don’t worry – you’ll learn that in your clinical years!”Indeed, it was accepted wisdom that two pre-clinical years of cramming information that would never be accessed again was a reasonable norm – that this was a good use of limited training time.

The sum effect of the diversion of time from learning about medicine to mastering an arcane level of detail more appropriate to research-guided PhDs is that the timeframe for learning clinical medicine is shoved into an accelerated five years for general medicine (or longer, for surgery or medical specialties).This feeds the pressure and rush of the residency years, as well as the back-pressure against resident work-hours reform – after all, there is a limited time in which to master this immense volume of clinical skill: six years have already been burned on other topics, so few are left for the meat of the career.This does not begin to address the investment expense required to throw six years of non-clinical training at every doctor – expense that is taken up by state funds and private debt alike, which in turn drives medical students away from critical but lower-paying careers like primary care.And in my experience, it is often the burn of the residency years that fundamentally shapes many physicians’ attitudes toward work, burnout, reimbursement, and debt.You cannot repay what young physicians endure during residency; most take it back the only way they can – monetarily.

True reform of the MCAT would mean a massive retrospective review of what pre-medical training and characteristics drive an acquisition of skill, an aptitude for the profession, and a likelihood of filling specialties we need most at this moment in time.True reform would also mean canning the entire content of the first step board exam in favor of material that is salient to the profession instead of cowing to the traditionalist ideal that every physician should have a classical education (which is promptly forgotten in favor of the vast chunk of knowledge that MDs are required to carry around in their heads day-to-day).No one is arguing for dropping the rigors of testing; but perhaps cutting the pre-med organic chemistry in favor of anatomy, or dropping the second semester of physics in favor of genetics, may actually produce more apt physicians who do not find themselves not behind the eight-ball of burnout so early in their career.

On its own the MCAT is certainly not a solo-flying herald or cause of inefficiency in the medical system.But it is the entry point into a system that emphasizes hell-bent tradition over efficiency or pragmatism at all points along the way – and it is no wonder that those who experience it come out the other end with a set of priorities that reflect the values of the training they endured.

In the past month or so I've developed a new pet peeve, one which can make me grit my teeth. I've noticed how often some variation on the phrase "we're hard wired to," gets said among the mid-high brow folks in the media. I've yet to start counting but my sense is that I'm hearing or reading it at least once a day in some form of media communication. That communication can turn a metaphor into a deeply entrenched habit of thought that becomes an effective and possibly damaging basis for actions.

The idea that we are "wired" is to reduce an incompressible phenomenon, our consciousness, our perception, our thought and our analyses into something that we believe we do understand, the computer. With that comes the comfort of believing we have a handle on something in service to the professional interests of the people who start off that chain of reductionist credulity. It's sustained by the desire of time-pressed and rather superficial academic and media scribblers to give their utterances a false caché of what they take to be cutting edge and exciting science. From there it goes on to be an unconsidered fashion accessory of superficial thought.

The idea that we are machines has become so widely believed and entrenched in what passes as the intelligentsia, that pointing out that the metaphorical and ideological substance of the phrase isn't backed up by anything but an ideological interpretation of extremely fuzzy science will get a pretty strong reaction.

The fact is that no one has anymore an idea of what consciousness is than they do what time is. Anyone who has tried to wade through the philosophical attempt to deal with time will inevitably confront the fact of the incomprehensibility of our consciousness, of the reality that the most basic of our our realities is undefinable and incomprehensible.

There is no reality that isn't intrinsically bound up with consciousness, "reality" is the word we use for what our consciousness perceives and understands. Time, in the only way it can have meaning to us, would seem to be intrinsically tied up with those problems but what we're doing is trying to conceive of the undefinable with something we don't know enough to even come up with the rules for doing that. We don't know how we know or what it means to know, we don't even know what it means to construct the product of our perception to create the limited image of the universe available to people. And we do construct the aspects of our sensory perceptions that we think about. Our thoughts are made by us.

I can't remember the scientist who speculated that for whatever consciousness which bacteria could have, gravity is essentially nonexistent, Brownian motion being entirely relevant to them, in its place. Of course that's all speculation. Though the idea that our perception of the universe and our place in it rules our most basic thinking about it seems to me to be the most sensible of statements. How a bacterium perceives the universe and its place in it is unavailable to us in any real way, but we can imagine how such an alien consciousness, so limited to its peculiar situation, would concieve of its existence in its habitat.* Perhaps that habit of thinking, the belief that our thinking about something like bacterial consciousness is understandable, is what's at work when we think about our own consciousness.

Computer science gives us some intellectual hold on the functioning of machine processing - which is no huge surprise since it was invented by computer science - which we use to organize and sift enormous amounts of information and the speed. The results of it, presented to our senses, seems like a form of consciousness and we are duped by that despite our knowing that human beings have done whatever was done. It tricks even some very bright people into pretending they don't know that it's a machine set into motion by very fast and very efficient but basically inert mechanics, prevented from doing some things and made to do some things by our mechanical and logical ingenuity. It doesn't reflect anything about whatever process consciousness is, about which we know nothing other than that it's there, without which no other aspect of existence is known, without which we don't exist. And we have no knowledge of what it is and where it comes from. Unlike the computer, our consciousness was not made by us to our specifications. Neither it's schematics nor its operational manual is available to us, we don't even know if it is linear or random or incomprehensibly unlimited in its ability. We don't even know if the analogies of schematics and operations are relevant to whatever consciousness is. We do know that our rational processing of information and even our most basic perception we use to think about such things is limited and that our metaphors really aren't identical to what they are used to describe.

The number of people who have an emotional reaction to pointing out that, whereas the machine is known to be he result of physical processes and phenomena brought out through our intentional design, is suggestive of a habit of our thinking, in itself. The fact is we don't have any real knowledge of any actual analog of consciousness in the physical world. The vehemence of that emotional reaction leads me to conclude that it's got motives apart from the mere defense of a scientific position, which the "hard wired" one really isn't. At its foundations and throughout its use, it's an assertion of dogmatic materialism.

Feminism, daily and inevitably, confronts entrenched ways of thought based in the selective and self-interested view of reality on behalf of men, obviously there but almost entirely unacknowledged. Most of it happens on the same, barely thought, level that "everyone knows we are hard wired" holds in our lives.

That ur-level view defines women as being less than and other than men and that, by nature, men are the default form of humanity, if not all of life which has gender. The denial of that orthodoxy causes an extremely emotional reaction which will grasp at any straw to deny women their person hood, their intellectual integrity, their most sacred rights as a human being. And what is thought and said about and done to women can be done to any other group of people whose intrinsic rights are ignored or denied. It is what allows the obnoxious banter of the "Market Place Report" about matters that dole out death to the many and even the biosphere to be so horrifically peppy.

Taking in a panoramic view of the reductionist ideology in scientific (and in a related way, non-scientific) thought and their resultant declarations, what that ideology frequently says about women is, I believe, intrinsically related to the idea that we are machines made of meat, meat which happens to come in two varieties, based in gender. The assertion is that women are "hard wired" differently than the way men are. Instead of being a light that illuminates an infinitely more complex reality of human beings it reduces us to a lower status than is ours by right. That reduction is an opaque cover for an ideology that reduces everything to the status of inert matter. And it reduces some more than others.

I believe the way out of that is to admit the unknowability of our consciousness, about what we really are. I believe the way out of that is to fearlessly assert that we are more than objects, that we are all more than objects with a higher status than the merely physical world our limited reason defines. We are undefinable and ineffable and our experience and human history shows us more than physics or mathematics or any other science is competent to tell us what the results of our collective, experienced life mean. History proves that the results of reducing any or all people to the same category of objects leads to them being considered in terms of commerce and use and exploitation. We must demand that people be treated better than that and there is no scientific method that can find the basis of that assertion. Our human experience can't make the connection between the subatomic structure of matter and our total experience of human beings living in a community and on the Earth. We have to find the basis of a decent life elsewhere.

The level of our conscious experience is not negligible or ignorable. The convenient and professionally and ideologically opportunistic reduction of it doesn't change that it is the real, effective higher level of existence that we actually live is that by which everything we know of the lower levels of matter is known. All of that is known only by an analogy and extension of our earliest, inarticulate, conscious experience, it literally can't escape that dependence on the humblest and simplest facts of that experience. All things we talk about are only inferential, in all their impressiveness.

* Habitat is, in a fundamental way, created by the organism, the organism creates the habitat. But I won't go into that today.

Note, also, that as far as we conceive of them being removed from us and our experience, a bacterium shares a lot with us, living on the same planet, having a physical existence in the same way we do. Any attempt to conceive of a conscious life even farther removed from that would completely exhaust our attempts at imagination.

Post script. Reading this over again, I realized it was the first part of something longer I've been thinking about for a long time. I can't tell you when the next installment will be forthcoming but I will link to this when it's posted.

Friday, May 20, 2011

For those of you who have read Tove Jansson's Moomin books or heard of them. This is a song called "Oh, tiny party-goer," and I believe that the lyrics are by the author herself. A rough translation:
Oh tiny party-goer,
Morning will dawn soon,
It's midnight already
You wander the road alone,
Your paws are tired
And you can't find the way home.

While reading this and other articles on the Medicare fights I suddenly realized that the conservatives' hankering over some mythical past when All Was Well in the world is most selective. Medicare was created almost fifty years ago, but they don't like it.

Though it's not just the conservatives who yearn for an imaginary past. Here's New York City mayor, Michael R. Bloomberg, on the new wave of bad parents:

“Unfortunately there are some parents who just come from — they never had a formal education, and they don’t understand the value of education,” Mr. Bloomberg said on the program, which is broadcast on WOR-AM (710).

He went on to observe: “The old Norman Rockwell family is gone.”

That is not only rude but also inaccurate. First, the Norman Rockwell family never existed. Rockwell was a painter who idolized certain aspects of the American experience, the way greeting cards do.

Second, the world in which Rockwell painted was full of people who had less formal education than the parents of today and many of them did not value education, at least based on the stories I have heard from older people.

Thursday, May 19, 2011

Fun and games, again, about powerful men and their sexual urges. An article in the Time magazine begins with the usual argument that men can sire any number of children most easily (because, you see, all one needs to have a child grow up into a mature individual ready to pass the genes on is a fertilized egg!), and this is why the male libido consists of trying to mate with as many women as possible. Unless self-restraint enters the picture. But what if it doesn't?

In some cases, though, the stability never happens; in some cases, unlimited opportunity simply leads to unlimited appetites. Emperors and despots may be best known for this kind of behavior. The 18th-century Moroccan ruler Moulay Ismail is said to have fathered 888 children with his 500 concubines. Genghis Khan makes Ismail look practically barren. A 2003 analysis of the Y chromosome of 2,123 men now living across the former Mongol empire showed that there are 16 million males living today whose line stretches back to the great conqueror — or one out of every 200 males now on the planet. But modern-day men of power — Donald Trump, Bill Clinton, Eliot Spitzer, John Edwards, John Ensign, JFK, FDR, and most recently, Arnold Schwarzenegger and Dominique Strauss-Kahn — with their serial wives or serial philandering, can behave just as badly, if less prolifically.

This the article calls the Caligula effect! Don't know about you, but I was taught that Caligula was utterly mad and cruel. Are we to take the Caligula effect as signifying that in the mentioned modern cases, too?

More interestingly, Moroccan ruler Moulay Ismail and the famous Genghis Khan didn't get to sire so many children (assuming they did) because of serial philandering or because they were ladies' men. That paragraph misses the point. A woman refusing John Edwards, say, doesn't get her head chopped off or her family murdered. I bet you anything that refusing Genghis Khan would have led to that very outcome.

In short, the quoted paragraph confuses possibly violent force, societal power and sexual attraction of men with power. It's all baked into one pie, called the Caligula effect. Possible rapes, women sold by their parents or taken by military force, willing mistresses or girlfriends, it's all the same!

Now why would someone write that way? Could it be because the writer views the world through testosterone glasses, meaning that the intended audience consists of men? How else could we explain this quote:

That same phenomenon, Josephs believes, may explain the public outrage when sexual misbehavior of elites — particularly the kind that involves violence or assault — become public. "We don't want our leaders to be philanderers," he says. "In an egalitarian society, nobody should monopolize all of the females or sleep with our wives, or we're going to get even."

Misbehavior of the kind which involves violence or assault?

And nosir, I don't want the elite to get hold of all my females, sigh, and I shall certainly get even.

How to explain an article like this? My guess is evolutionary psychology of the stupid kind as the background noise, baked into a pie with some confusion about what sexual assault might mean. And that male gaze, naturally.

This is a funny take on the end of the world, scheduled for May 21st, 2011. Though strictly speaking the hell fires (why is hell seen as a hot place and not an ice float?) aren't supposed to be lit in the first round. That consists of the Raptured suddenly disappearing. Hell enters the picture a bit later, after some earthly torture for the sinners.

Wednesday, May 18, 2011

Atrios refers to this post about the mass discipline of the Republicans:

Most clear-eyed political observers thought that Newt Gingrich's candidacy would be unsuccessful, but no one could have foreseen just how rapidly it would implode. Forget about the Tiffany's revelation -- after criticizing Paul Ryan's plan to turn Medicare into a voucher program, Gingrich was actually forced to call Ryan to apologize. Just imagine how humiliating that must have been for someone who sees himself as a world-historical figure. But this episode is about more than Gingrich.

That THE LEFT demands complete ideological purity has been an article of faith for as long as I can remember.

But it is increasingly true of the Right, that there is a growing list of views and beliefs which one must adhere to.

I don't know enough about the purity demands of the old left to comment on that part, though trying to make liberals or progressives to work together on a concrete goal often amounts to trying to herd cats.

So yes, I agree that rigid demands of identical ideologies are somewhat nasty and bring to mind goose stepping and similar unpleasant concepts. I also agree that this rigidity is currently more common on the right than on the left, at least in the sense of successful unification of everyone behind a detailed set of principles.

At the same time, the "big tent" concept has its own problems. Not much gets achieved with that cat-herding, and the need to bargain with those who hold a different set of basic principles can result in the sort of ugliness where someone else's basic principles are pawns in the eleventh-dimensional chess game the Obama administration is rumored to play.

Just a night of dudes being dudes, bros being bros, but there’s a lot of this going around Manhattan media these days. In fact, you don’t have to look farther than the youngish, vaguely athletic, literate and street-jargoned top editors at The New York Times Magazine, Bon Appétit and Bloomberg BusinessWeek. They’re dudes; they’re editors. Ladies and dudes, meet the Dude-itors. These are not the editors who call you “Mr.” and “Miss,” as famed New Yorker editor William Shawn once did — although he did drive an M.G. convertible on the weekend. These guys say “Hey, man” as a salutation. Dude-itors don’t practice lines for lunch at the Century Association — they practice their golf swing in the office, toss around Nerf footballs when an issue is closing, and occasionally play pickup basketball together.

Delicious! As Matt Yglesias points out in a tweet, dude editors are as rare as female nurses! A story worth telling.

If John Koblin, the writer of this piece, was in the business of manufacturing after-shave, all he would need to do is to condense this and put it in a bottle.

The first Slutwalk was held in Canada. Boston soon followed, then several other Slutwalks and several more are being planned in various countries.

That the initial trigger seems to be out of proportion (a police officer speaking to ten students in Toronto) to the response (large protests far away from the initial incident) tells us that this is a grass roots movement (among some groups of women (and men), at least), fired by the still common victim blaming when it comes to sexual violence.

Tuesday, May 17, 2011

Reading the obituaries, once again, I see that the playwright Pam Gems died last Friday. (Isn't "Pam Gems" an excellent name?) In college, a friend put on a showcase of scenes from several Gems plays, and then got one of the professors in the English department to add Gems' "Queen Christina" to the syllabus during her final semester.

In 1970, after the family moved to London, she found her way to the fringe theater movement then taking shape. Already in her 40s, she made an awkward fit initially. "I was often called reactionary,” she told The Daily Telegraph of London in 2006. “The first time I went to a women’s group I took jam, because that’s what you do in the country — I was that naïve."

She soon found her footing and her subject, the complexities of women’s lives, which she explored in plays like “Betty’s Wonderful Christmas,” the monologues “My Warren” and “After Birthday,” and “The Amiable Courtship of Miz Venus and Wild Bill,” her first full-length play. “I realized that there was no authentic work about women: they were occasionally celebrated but never convincingly explored," she told the magazine Spare Rib in 1978.

Emotions ran hot at the time. On the opening night of “Go West, Young Woman,” about female American pioneers, at the Roundhouse in Chalk Farm, two feminist groups halted the production because it included male characters.

Right to Life New Mexico was attempting Monday to have an endorsement removed from a pro-life billboard on White Sands Boulevard between First Street and Second Street. The billboard went up sometime during the weekend.
The billboard depicts an Alamogordo businessman, GEFNET owner Greg A. Fultz, holding what appears to be an outlined baby in his arms as he is looking down at it. Next to the picture, in large print, is the statement, "This Would Have Been A Picture Of My 2-month Old Baby If The Mother Had Decided To Not KILL Our Child! [sic]."
Fultz, 35, said he created the organization, National Association of Needed Information (N.A.N.I.), to dispense his pro-life message.

It's my belief that fathers should have a say regarding pregnancy. Women have all the power when it comes to pregnancy. The men get no say when a woman wants to go and have an abortion without the say of the father. I believe that is wrong because men are 50 percent of the result of the pregnancy. They should have an equal right to their unborn child and decisions regarding it."

Mmm. Except that men can't get pregnant or face the very real health risks of pregnancy.

A prestigious Yale fraternity that counts both Bush presidents among its alumni is being banned from recruiting and activities on campus for five years after pledges were ordered to chant obscenities against women.
Yale says it has also disciplined several Delta Kappa Epsilon members and asked the fraternity's national office to suspend the chapter for five years.

"Obscenities" is such a fuzzy word, compared to "No Means Yes. Yes Means Anal." That's what the pledges chanted.

If you read the whole piece you get a slightly bowdlerized version of the chant. Still, I think the term "obscenities" is not the correct one to use in this context. It lacks the threat aspect of the actual chant and suggests that all this is just a lot of fuss about some harmless college capers.

Strauss-Kahn is the chief of the International Monetary Fund (IMF) and was expected to be a candidate in France's next presidential elections. Until last Saturday, that is, when he was taken off a plane bound for Paris because a hotel housekeeper accused him of sexually assaulting her at the Sofitel hotel in New York City.

When I read the story my first reaction was that there is something good about a country in which the police is willing to detain and question the head of the IMF on the say-so of a hotel maid. Justice should always be impartially administered but it is not.

I'm not going to try Mr. Strauss-Kahn on this here blog. But I AM going to question this recent article on the case:

Amid charges of sexual abuse and rape, Dominique Strauss-Kahn's ladies' man reputation may be working against him.
Nicknamed "the Great Seducer," the International Monetary Fund chief has spoken publicly about his affinity for women and his infidelity. And while flirting and cheating are a far cry from the current allegations, some experts say they fall onto the same spectrum of sexual inappropriateness.

Some experts say! The same spectrum of inappropriateness? Would one end of it consist of flirtatious comments and the other end of violent rape? It's like saying that scowling at your neighbors and hiring a hit-man to kill them are behaviors along the same spectrum of inappropriateness.

Let's not forget, amid all this talk about flirting and being a ladies' man, that Strauss-Kahn is accused of this:

...forcing a housekeeper at Manhattan's Sofitel Hotel to perform oral sex and submit to anal sex after emerging naked from his suite's bathroom.

As IMF head and a possible contender for the French presidency, Strauss-Kahn joins a long list of high-profile politicians, actors and athletes accused of sexual indiscretions that shattered their careers and marriages. And while one might ask, "What were they thinking?" experts say they might not have been thinking at all.

Monday, May 16, 2011

There he goes again, this time with a Psychology Today blog post which argues that black women, on average, are uglier than other women. This, finally, was too much even for the happy-go-lucky-if-it-means-extra-clicks Psychology Today, the bargain bin of Freud and Jung and Kanazawa! And so poor Kanazawa's post got deleted.

But worry not! It's still available for your perusal. Not that I recommend such perusal. You should just stay here with me and remind yourself that Kanazawa's research has been found a bit flawed in the past, and a quick glance through the deleted post makes me suspect that this particular piece is more flawed than just a bit. For instance, Kanazawa writes:

At the end of each interview, the interviewer rates the physical attractiveness of the respondent objectively on the following five-point scale: 1 = very unattractive, 2= unattractive, 3 = about average, 4 = attractive, 5 = very
attractive. The physical attractiveness of each Add Health respondent is measured three times by three different interviewers over seven years.

That's objective??? What makes it objective? Using a scale? I'd call that silly. I could make up a scale and use it on Kanazawa's research, for instance, but I bet he wouldn't regard that as objective.

Let's not forget that we are not being shown all the data in whatever Kanazawa has been doing. We don't know the average age, sex and race distributions of the respondents, we don't know the age, race or sex of the interviewers, and we can't follow his steps in the factor analysis. Knowing all that is relevant if one wishes to critique Kanazawa's work.

But it doesn't really deserve that. Because there is no "objective" measure of physical attractiveness, if by "objective" we mean something that would not vary by time and place.

Remember when you were a kid and all the pronouns in the textbook were "He" and "Him"? Well, that is not the case anymore in great part because of Kate Swift, who died yesterday and whose obituary you can read here.

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